Diagnostic Accuracy of Magnetic Resonance Arthrography in Detecting Intra-articular Pathology Associated with Femoroacetabular Impingement

Abstract

Purpose The aim of this study was to assess the diagnostic accuracy of magnetic resonance arthrography (MRA) in the detection of intra-articular lesions of the hip in patients affected by femoroacetabular impingement (FAI) by using arthroscopy as reference standard. Methods Twenty-nine consecutive hip arthroscopies performed in 24 patients were considered for the study. Patients had a mean age of 38.3 years. Ultrasound-guided 1.5-T MRA was performed with precontrast short tau inversion recovery, T1-weighted and PD coronal, T1-weighted, and T2-weighted axial with 3-mm-thick slice sequences, and postcontrast T1-weighted fat saturation MRA (Fat-SAT) axial, coronal and oblique sagittal, and T1-weighted Vibe 3D coronal sequences with MPR sagittal, axial, and radial reconstructions with 2-mm-thick slice and coronal density protonil (DP) Fat-SAT. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRA were evaluated by comparison arthroscopy for the following intra-articular findings: acetabular and femoral chondral lesions, labral degeneration, labral tears, synovitis, ligamentum teres (LT) tears, CAM lesions, pincer lesions, loose bodies, and osteophytes. Results An absolute per cent agreement (100%) was observed for all the variables in the assessment of CAM lesions. Sensitivity, specificity, PPV, and NPV of MRA were 100, 68.4, 72.7, and 100%, respectively, for acetabular chondral lesions; 100, 50, 47.3, and 100%, respectively, for femoral chondral lesions; 33, 85, 20, and 91.6%, respectively, for labral tears; 95, 71, 91.3, and 83.3%, respectively, for labral degeneration; 100, 88, 57.1, and 100%, respectively, for LT tears; 33.3, 85, 50, and 73.9%, respectively, for pincer lesions; 50, 96, 66.6, and 92.3%, respectively, for intra-articular loose bodies; and 100, 73.9, 50, and 100%, respectively, for osteophytes. Conclusion MRA may play an important role in detecting intra-articular lesions associated with FAI. This might be helpful for the preoperative planning before hip arthroscopy. Level of Evidence This is a Level 2, diagnostic accuracy study compared with gold standard.

3.0 T MRI is more recommended to detect acetabular labral tears than MR Arthrography: an updated meta-analysis of diagnostic accuracy

“…After a systematic search in the above databases, 68 studies were initially selected, and finally, twenty-two studies were included according to the inclusion and exclusion criteria, including 1670 participants [ 4 – 25 ]. Of the twenty-two studies for the meta-analysis, nineteen studies reported diagnostic results for MRA [ 4 – 6 , 8 – 21 , 23 , 25 ] and ten studies reported diagnostic results for MRI [ 4 , 7 , 9 , 13 , 15 , 16 , 20 , 22 – 24 ]. One study reported the diagnostic results for MRI with a large field of view (LFV) and a small field of view (SFV) respectively [ 9 ].…”

“…Based on the QUADAS-2 criteria, most studies presented a low risk of bias and concern regarding applicability. Only one study in which the reference standard results were interpreted without knowledge of the results of the index test [ 21 ]. Besides, six studies were unclear as to whether the index test results were interpreted without knowledge of the results of surgical findings [ 4 , 6 , 10 , 17 , 18 , 23 ].…”

“…However, the reference test blinded design is impractical in clinical practice. Only one study reported the surgeons were unaware of imaging findings [ 21 ].…”